Test-retest reliability of the Swedish version of the Modified Fatigue Impact Scale in people with mild to moderate multiple sclerosis.
Fatigue is a subjective lack of physical and/or mental energy and is commonly perceived by people with multiple sclerosis (MS). People with MS often describe fatigue as the most troublesome MS related impairment, and it also has a negative impact on ability to initiate or maintain activities as well as work capacity and health related quality of life. The Modified Fatigue Impact Scale (MFIS) is a patient-reported outcome measurement of fatigue. The scale consists of 21 items divided into three subscales to capture the cognitive (10 items), physical (9 items) and psychosocial (2 items) dimensions of fatigue. MFIS is translated to Swedish but not evaluated for test-retest reliability for use in Swedish settings of rehabilitation or research. The aim of the study was to investigate the test-retest reliability of the total score and the scores of the subscales of the Swedish version of the MFIS in people with mild to moderate MS-disability.
Eligible study participants were people with mild to moderate overall MS-disability according to the Expanded Disability Status Scale (EDSS) - EDSS score from 2.0 to 5.5. The included participants completed the Swedish version of MFIS at two occasions, one week apart. Intraclass Correlation Coefficient (ICC) agreement was used to analyse the test-retest reliability of the total score and a quadratic weighted Cohen's kappa was used to analyse the subscale scores. Further, measurement error, smallest detectable change (SDC), and limits of agreement (LOA) were calculated for the total score of the whole sample.
A total of 54 people with MS were included in the study. The mean age was 50 years and 70 % were female. The mean overall MS-disability were 3.7 according to the EDSS, 28 of the participants had mild MS-disability (EDSS 2.0 to 3.5) and 26 of the participants had moderate MS-disability (EDSS 4.0 to 5.5). Results of test-retest reliability for the whole sample of the total score of the MFIS were acceptable with an ICC value of 0.84, a measurement error of 8.2, an SDC of 22.6 and LOA of 23.3 and -22.4. The ICC values of the total score were also acceptable for the subgroups with mild MS-disability and moderate MS-disability with ICC values of 0.83 and 0.74. The kappa values for the whole sample showed excellent or fair to good test-retest reliability of the physical, cognitive and psychosocial subscales with values of 0.83, 0.84, and 0.75.
The results of this study show that the total score of the Swedish version of MFIS is a reliable measure and a change of 23 points indicates a true change in fatigue impact in people with mild to moderate MS-disability. The test-retest reliability of the cognitive and the physical subscales were considered as excellent, and the psychosocial subscale as fair to good. The total score of the scale can be recommended for use in Swedish populations.
Sundström B
，Johansson S
，Wallin A
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Japanese translation and validation of the 12-item Multiple Sclerosis Walking Scale version 2.
Disability in ambulation has a critical impact on activities of daily living in patients with multiple sclerosis (MS). The 12-item Multiple Sclerosis Walking Scale (MSWS-12) is a self-reported instrument developed to assess the impact of MS on walking. The scale's 12 items assess various aspects of walking-related tasks during the past 2 weeks. MSWS-12 has been used in multiple clinical studies and translated into several languages. In the present study, we translated the MSWS-12 into Japanese and evaluated its psychometric properties in a cross-sectional study.
The original English MSWS-12 version 2 (v2) was translated into Japanese through a standard procedure. Sixty consecutive Japanese MS patients completed the newly prepared Japanese MSWS-12v2 questionnaire and repeated the test 14 days later. Physical disability was assessed by the Expanded Disability Status Scale (EDSS), Timed 25-foot Walk (T25FW), and 9-hole Peg Test (9HPT). Cognitive performance was evaluated using the Processing Speed Test (PST). Fatigue and health-related quality of life were assessed using the Japanese versions of the Fatigue Severity Scale (FSS) and the Functional Assessment of MS (FAMS).
The mean age of the patients was 42.5 years, with median disease duration of 10 years, and median EDSS of 2.0 (range 0, 6.5). Forty-seven patients (78.3 %) had relapsing-remitting, 9 (15.0 %) had secondary-progressive, and 4 (6.7 %) had primary-progressive phenotypes. The median score of the MSWS-12v2 was 5.95 (interquartile range 0, 50.6). Twenty-seven patients (45 %) scored the lowest possible score (0 points), while one (1.7 %) scored the highest possible score (100 points). Cronbach's alpha was 0.98 (95 % confidence interval [CI] 0.97, 0.98), and the test-retest intraclass correlation was 0.95 (95%CI 0.94, 0.96). MSWS-12v2 score was strongly correlated with EDSS (Spearman's ρ = 0.73 [95%CI 0.58, 0.83]), T25FW (ρ = 0.70 [95%CI 0.55, 0.81]), and total FAMS score (ρ = -0.80 [95%CI -0.88, -0.69]), and moderately correlated with 9HPT (ρ = 0.65 [95%CI 0.47, 0.77] for the dominant hand; ρ = 0.62 [95%CI 0.43, 0.75] for the non-dominant hand), PST (ρ = -0.65 [95%CI -0.78, -0.47]), and FSS (ρ = 0.68 [95%CI 0.52, 0.80]). Among the subcomponents of FAMS, the mobility subcomponent showed the most robust correlation with MSWS-12v2 score (ρ = -0.91 [95%CI -0.94, -0.81]). In patients with minimal or no objective disability (EDSS < 3.0, n = 40), only the mobility subcomponent of FAMS was strongly correlated with MSWS-12v2 score (ρ = -0.76 [95% CI -0.87, -0.58]). In contrast, correlations of MSWS-12v2 score with EDSS and T25FW were weak in this subgroup (ρ = 0.28 [95%CI -0.03, 0.55] for EDSS; ρ = 0.25 [95%CI -0.06, 0.52] for T25FW). Response patterns for the single items showed that 32.5 % of the patients with EDSS below 3.0 reported having problems with balance, followed by climbing stairs and standing while doing things (both 25 %).
The Japanese version of the MSWS-12v2 developed in this study is reliable, valid, and helpful for screening walking disability in Japanese MS patients, including those with minimal objective disability.
Miyazaki Y
，Niino M
，Takahashi E
，Sato C
，Naganuma R
，Amino I
，Akimoto S
，Minami N
，Kikuchi S
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The Ultrashort Mental Health Screening Tool Is a Valid and Reliable Measure With Added Value to Support Decision-making.
Mental health influences symptoms, outcomes, and decision-making in musculoskeletal healthcare. Implementing measures of mental health in clinical practice can be challenging. An ultrashort screening tool for mental health with a low burden is currently unavailable but could be used as a conversation starter, expectation management tool, or decision support tool.
(1) Which items of the Pain Catastrophizing Scale (PCS), Patient Health Questionnaire (PHQ-4), and Brief Illness Perception Questionnaire (B-IPQ) are the most discriminative and yield a high correlation with the total scores of these questionnaires? (2) What is the construct validity and added clinical value (explained variance for pain and hand function) of an ultrashort four-item mental health screening tool? (3) What is the test-retest reliability of the screening tool? (4) What is the response time for the ultrashort screening tool?
This was a prospective cohort study. Data collection was part of usual care at Xpert Clinics, the Netherlands, but prospective measurements were added to this study. Between September 2017 and January 2022, we included 19,156 patients with hand and wrist conditions. We subdivided these into four samples: a test set to select the screener items (n = 18,034), a validation set to determine whether the selected items were solid (n = 1017), a sample to determine the added clinical value (explained variance for pain and hand function, n = 13,061), and a sample to assess the test-retest reliability (n = 105). Patients were eligible for either sample if they completed all relevant measurements of interest for that particular sample. To create an ultrashort screening tool that is valid, reliable, and has added value, we began by picking the most discriminatory items (that is, the items that were most influential for determining the total score) from the PCS, PHQ-4, and B-IPQ using chi-square automated interaction detection (a machine-learning algorithm). To assess construct validity (how well our screening tool assesses the constructs of interest), we correlated these items with the associated sum score of the full questionnaire in the test and validation sets. We compared the explained variance of linear models for pain and function using the screening tool items or the original sum scores of the PCS, PHQ-4, and B-IPQ to further assess the screening tool's construct validity and added value. We evaluated test-retest reliability by calculating weighted kappas, ICCs, and the standard error of measurement.
We identified four items and used these in the screening tool. The screening tool items were highly correlated with the PCS (Pearson coefficient = 0.82; p < 0.001), PHQ-4 (0.87; p < 0.001), and B-IPQ (0.85; p < 0.001) sum scores, indicating high construct validity. The full questionnaires explained only slightly more variance in pain and function (10% to 22%) than the screening tool did (9% to 17%), again indicating high construct validity and much added clinical value of the screening tool. Test-retest reliability was high for the PCS (ICC 0.75, weighted kappa 0.75) and B-IPQ (ICC 0.70 to 0.75, standard error of measurement 1.3 to 1.4) items and moderate for the PHQ-4 item (ICC 0.54, weighted kappa 0.54). The median response time was 43 seconds, against more than 4 minutes for the full questionnaires.
Our ultrashort, valid, and reliable screening tool for pain catastrophizing, psychologic distress, and illness perception can be used before clinician consultation and may serve as a conversation starter, an expectation management tool, or a decision support tool. The clinical utility of the screening tool is that it can indicate that further testing is warranted, guide a clinician when considering a consultation with a mental health specialist, or support a clinician in choosing between more invasive and less invasive treatments. Future studies could investigate how the tool can be used optimally and whether using the screening tool affects daily clinic decisions.
Level II, diagnostic study.
Wouters RM
，de Ridder WA
，Slijper HP
，Vermeulen GM
，Hovius SER
，Selles RW
，Hand-Wrist Study Group
，van der Oest MJW
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ResearchGate
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